Steroid-induced avascular necrosis: A case report on a patient treated with steroid therapy for COVID-19. (August 2022)

• Record Type: Journal Article
• Authors: Maharjan, Gyabina; Yadav, Stuti; Yadav, Mandeep Kumar; khati, Nirajan; Bhattarai, Himal Bikram; Joshi, Jaydev
• Is Part Of: Annals of medicine and surgery. Volume 80(2022)
• Publication Date: 2022-08
• Subjects: COVID-19 -- Avascular necrosis -- Corticosteroid; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104226
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: COVID-19 must get a combined approach that involves epidemiology, surveillance, accurate diagnosis, and prophylaxis. Corticosteroids use in the treatment of COVID-19, for a long time at high doses, can cause steroid-induced avascular necrosis. Case report: The patient is a 22-year-old female. She came with a complaint of bilateral groin pain for 4 months. The pain was abrupt in onset, continuous, non-radiating, aggravated by walking and relieved with rest. We did an X-ray of the bilateral hips, blood tests, and MRI. With the investigations, we established the diagnosis of avascular necrosis of the femoral head. Discussion: Ischemia of the femoral head is caused by any interruption in the blood supply of the acetabulum. It is induced by high-dose and long-term steroid usage. Glucocorticoids affect the metabolism of lipids which results in the formation of fat emboli and lipoprotein globules. This blocks peripheral vessels and leads to necrosis of the bone due to ischemia. Conclusion: Avascular necrosis of the femoral head has been reported in patients treated with corticosteroids while being treated for COVID-19. So, physicians should keep it as a possible diagnosis and enhance their knowledge on this topic. Highlights: COVID-19 treatment also involves the use of corticosteroids. The use of corticosteroids, for a long time at high doses, can cause steroid-induced avascular necrosis. Glucocorticoids affect lipids' metabolism, which further blocks peripheral vessels causing necrosis. Regular screening is required for patients who have received corticosteroids.